Biomechanical evaluation of an injectable radiopaque polypropylene fumarate cement for kyphoplasty in a cadaveric osteoporotic vertebral compression fracture model

Vertebral compression fractures cause pain, deformity, and disability. Polypropylene fumarate (PPF) has shown promise as an injectable cement for bone defects but little is known about its performance for kyphoplasty. The purpose of this study was to evaluate the biomechanical performance of PPF for kyphoplasty in simulated anterior compression fractures in cadaveric vertebral bodies. Thirty-one vertebral bodies (T9 to L4) from osteoporotic cadaveric spines were disarticulated, stripped of soft tissue and compressed on a materials testing machine to determine pretreatment strength and stiffness. All fractures were repaired with inflatable balloon tamps and either polymethylmethacrylate or PPF-30 (containing 30% barium sulfate by dry weight) cement and then retested. Strength restoration with PMMA and PPF-30 were 120% and 104%, respectively, of the pretreatment strengths. For stiffness, PMMA and PPF-30 restored vertebral bodies to 69% and 53%, respectively, of the initial values. There was no significant difference in treatment with either PMMA or PPF-30. The biopolymer PPF-30 exhibits mechanical properties similar to PMMA in a cadaveric kyphoplasty model. PPF biopolymer may be a suitable alternative for kyphoplasty.